Quitting driving: Families key but docs have role

Doctors aren’t trained to evaluate driving ability, and the study couldn’t tell if some drivers were targeted needlessly, noted Dr. Matthew Rizzo of the University of Iowa. Yet he called the research valuable.

“The message from this paper is that doctors have some wisdom in knowing when to restrict drivers,” said Rizzo. His own research shows some cognitive tests might help them better identify who’s at risk, such as by measuring “useful field of view,” essentially how much your brain gleans at a glance — important for safety in intersections.

—Walk 10 feet down the hallway, turn around and come back. Taking longer than 9 seconds is linked to driving problems.

—On a page with the letters A to L and the numbers 1 to 13 randomly arranged, see how quickly and accurately you draw a line from 1 to A, then to 2, then to B and so on. This so-called trail-making test measures memory, spatial processing and other brain skills, and doing poorly has been linked to at-fault crashes.

—Check if people can turn their necks far enough to change lanes, and have the strength to slam on brakes.

Dr. Gary Kennedy, geriatric psychiatry chief at New York’s Montefiore Medical Center, often adds another question: Are his patients allowed to drive their grandchildren?

“If the answer to that is no, that’s telling me the people who know the patient best have made a decision that they’re not safe,” said Kennedy, who offers “to be the bad cop” for families or primary care physicians having trouble delivering the news.

There are no statistics on how often doctors do these kinds of assessment.

“It’s this touchy subject that nobody wants to talk about,” said Dr. Marian Betz of the University of Colorado, whose surveys show most senior drivers don’t think their doctors know whether they drive. She is testing if an advance directive would help get older adults talking with their doctors about how to keep watch on their driving fitness before trouble arises.

More objective measures are needed — and to help find them, hundreds of older drivers are letting scientists install video cameras, GPS systems and other gadgets in their cars as part of massive studies of everyday driving behavior.

Identifying who needs to quit should be a last resort, said Jon Antin of the Virginia Tech Transportation Institute. He helps oversee data collection for a study that’s enrolling 3,000 participants, including hundreds of seniors, in Florida, Indiana, New York, North Carolina, Pennsylvania and Washington. The drivers undergo a battery of medical checks before their driving patterns are recorded for 12 to 24 months.

“If you identify people at risk, maybe you can intervene to prolong the safe driving period,” agreed Dr. Shawn Marshall of the Ottawa Hospital Research Institute. He helps lead Canada’s CanDrive II, a project that’s tracking 928 drivers in their 70s for five years, to see how their driving changes as they get older.

For now, advocacy groups like the Alzheimer’s Association and AARP offer programs to help families spot signs of driving problems and determine how to talk about it.

“I would like to think that my husband would say, ‘You really shouldn’t be driving anymore’ and I wouldn’t get mad at him,” said Sally Harris, 75, of Crystal Lake, Ill., who took AARP’s “We Need to Talk” program in hopes of broaching the subject with a 90-year-old friend who’s having driving problems.

Others turn to driver rehabilitation specialists, occupational therapists who can spend up to four hours evaluating an older driver’s vision, memory, cognition and other abilities before giving him a behind-the-wheel driving test. Some doctors and state licensing authorities order those evaluations, but programs can be hard to find, often have waiting lists and cost several hundred dollars that insurance may not cover.

Having a professional involved can keep family relationships intact, said Pam Bartle, a driver rehab specialist at Marianjoy Rehabilitation Hospital in Wheaton, Ill.

Still, “you could have the sweetest, nicest little old lady and she’ll turn on you on a dime if you tell her she can’t drive,” Bartle said. “It’s a desperate thing for people. They can’t imagine how they’ll manage without driving.”